AUTISM

Autistic individuals typically have problems processing auditory information. One auditory processing problem occurs when a person hears speech sounds but he/she does not perceive the meaning of the sounds. For example, if someone says the word ‘shoe,’ the person may hear the speech sound, but he/she does not understand the meaning of the sound. Sometimes the lack of speech comprehension is interpreted by others as an unwillingness to comply. However, the person may not be able to retrieve the meaning of the sound at that particular time.

Eric Courchesne of the University of California at San Diego has found significant impairments in auditory processing in autistic individuals using P300 brain wave technology (see Courchesne, 1987 for a review). The P300 brain wave occurs 300 milli-seconds after the presentation of a stimulus. (The ‘P’ refers to the positive polarity of the brain wave.) The P300 is associated with cognitive processing, and this brain wave is considered an indication of long-term memory retrieval (Donchin, Ritter, & McCallum, 1978). Edelson et al. (1999) examined auditory P300 activity prior to and three months following auditory integration training (AIT). Three autistic individuals participated in the experimental AIT group and two autistic individuals participated in a placebo group. Prior to AIT, all five individuals had abnormal auditory P300 activity, indicating an auditory processing problem. Three months following AIT, the results showed dramatic improvement in P300 activity for those who received AIT (i.e., a normalization of P300 activity) and found no change in those who received the placebo.

We do not know the underlying reason for auditory processing problems in autism; however, autopsy research by Drs. Bauman and Kemper have shown that an area in the limbic system, the hippocampus, is neurologically immature in autistic individuals (Bauman & Kemper, 1994). The hippocampus is responsible for sensory input as well as learning and memory. Basically, information is transferred from the senses to the hippocampus, where it is processed and then transferred to areas of the cerebral cortex for long-term storage. Since auditory information is processed in the hippocampus, the information may not be properly transferred to long-term memory in autistic individuals.

Auditory processing problems may also be linked to several autistic characteristics. Autism is sometimes described as a social-communication problem. Processing auditory information is a critical component of social-communication. Other characteristics that may be associated with auditory processing problems include: anxiety or confusion in social situations, inattentiveness, and poor speech comprehension.

Interestingly, those individuals who do not have auditory processing problems are often ‘auditory learners.’ These children do very well using the Applied Behavior Analysis (ABA) approach, whereas those who are visual learners do not do as well with this approach (McEachin, Smith and Lovaas, 1993). Given this, one might suspect that many visual learners have auditory processing problems and that visual learners will do quite well with a visual communication/instruction approach. It is also possible to provide visual support with ABA programs that have an auditory component. In this way, the visual learner can process the auditory information more easily.

The better autistic children understand auditory information, the better they can comprehend their environment, both socially and academically. The better we understand the autistic child, the better we can develop ways to intervene in an effective manner.

The autistic savant is one of the most fascinating cognitive phenomena in psychology. "Autistic savant" refers to individuals with autism who have extraordinary skills not exhibited by most persons. Historically, individuals with these exceptional skills were called 'idiot savants,' a French term meaning unlearned (idiot) skill (savant). In a 1978 article in Psychology Today, Dr. Bernard Rimland introduced a more appropriate term 'autistic savant,' which is the current label.

The estimated prevalence of savant abilities in autism is 10%, whereas the prevalence in the non-autistic population, including those with mental retardation, is less than 1%.

There are many forms of savant abilities. The most common forms involve mathematical calculations, memory feats, artistic abilities, and musical abilities. A mathematical ability which many autistic individuals display is calendar memory. They could be asked a question like: 'What day of the week was May 22, 1961? and they can determine the answer within seconds--Monday. Others can multiply and divide large numbers in their head and can also calculate square roots and prime numbers without much hesitation.

Examples of some memory feats include: remembering everything about presidents (birth/death, term in office, names and birth dates of family members, cabinet members, etc.), memorizing the U.S. highway system, and remembering everyone's birth date, even after meeting the person once and not seeing him/her for 20 years.

Some autistic individuals with savant abilities are incredible artists. Dr. Rimland's son, Mark, is quickly establishing himself as an excellent watercolor artist. A child named Nadia drew beautiful pictures of horses, and her drawings have been compared to those of Rembrandt. Interestingly, she lost her drawing abilities when she started to learn to speak. Another artist with autism, Richard Wawro, who was described in an issue of Reader's Digest, is legally blind and draws in crayons. His works sell for up to $10,000, even the Pope owns one of his paintings.

Music is another common savant ability. Many performers with autism have perfect pitch and also have a great memory for music. In some cases, a person can hear a classical piece once and play it back in its entirety. Tim Baley, who also has Fragile X, is a concert pianist and the piano player for Hi Hopes, a musical group of singers and performers with autism and/or mental retardation. Hi Hopes played at the Los Angeles autism conference a few years ago and have even played at the White House. (Tim's mother wrote a book about his life. If you would like to obtain a copy of her book or learn more about Tim, you can write to: Mrs. Baley, Box 8207, Anaheim, CA 92812).

The movie Rain Man exposed millions of people to autism as well as the autistic savant phenomenon. (Unfortunately, some people now have the impression that all autistic individuals have these abilities.) In the movie, Raymond displayed a great memory for ball player statistics, memorized parts of the telephone book, and counted cards in Las Vegas. One wonders why this year's national autism conference is being held in Las Vegas!

The reason why some autistic individuals have savant abilities is not known. There are many theories, but there is no evidence to support any of them. For example, Dr. Rimland speculates that these individuals have incredible concentration abilities and can focus their complete attention to a specific area of interest. Admittedly, researchers in psychology feel that we will never truly understand memory and cognition until we understand the autistic savant.

In the late 1980's, Dr. Eric Courchesne used magnetic resonance imaging (MRI) to examine whether autistic individuals have any structural brain abnormalities. He found that two areas of the cerebellum, lobules VI and VII, were significantly smaller in autistic individuals than in the non-autistic population. This abnormality is called 'hypoplasia' and seems to hold for all ages. Those who were more impaired tended to have much smaller lobules. Interestingly, there were a small group of autistic individuals whose lobules VI and VII were much larger than normal; this condition is called 'hyperplasia.'

One of the most characteristic symptoms of autism is a dysfunction in social behavior. Numerous reports written by parents and researchers have described this problem, and it is thought by many to be the key defining feature of autism. The social problems can be classified into three categories: socially avoidant, socially indifferent, and socially awkward.

Socially avoidant. These individuals avoid virtually all forms of social interaction. The most common response is tantrumming and/or 'running away' when someone tries to interact with him/her. As infants, some are described as 'arching their back' from a caregiver to avoid contact.

For many years, it was thought that this type of reaction to their social environment indicated that autistic individuals did not like or were fearful of people. Another theory, which is based on interviews with autistic adults, suggests that the problem may be due to hypersensitivity to certain sensory stimuli. For example, some state that a parent's voice hurt their ears; some describe the smell of their parents' perfume or cologne as offensive, and others describe pain when being touched or held.

Socially indifferent. Individuals who are described as 'socially indifferent' do not seek social interaction with others (unless they want something), nor do they actively avoid social situations. They do not seem to mind being with people; but at the same time, they do not mind being by themselves. It is thought that this type of social behavior is common in the majority of autistic individuals. One theory is that autistic individuals do not obtain 'biochemical' pleasure from being with people. Research by Professor Jaak Panksepp at Bowling Green State University in Ohio has shown that beta-endorphins, an endogenous opiate-like substance in the brain, is released in animals during social behavior. Additionally, there is evidence that the beta-endorphin levels in autistic individuals is elevated so they do not need to rely on social interaction for pleasure. Some research on the drug, naltrexone, which blocks the action of beta-endorphins, has shown to increase social behavior!

Socially awkward. These individuals may try very hard to have friends, but they cannot keep them. This problem is common among those with Asperger Syndrome. One reason for their failure to make enduring social relationships with others may be the lack of reciprocity in their interactions, since their conversations often revolve around themselves and are self-centered. Furthermore, they do not learn social skills and social taboos by observing others, and they often lack common sense when making social decisions.

In addition to the above three types of social deficits, the social cognition of autistic individuals may also be dysfunctional. Recent research has shown that many autistic individuals do not realize that other people have their own thoughts, plans, and points of view. They also appear to have difficulty understanding other people's beliefs, attitudes, and emotions. As a result, they may not be able to anticipate what others will say or do in various social situations. This has been termed as a lack of 'theory of mind.'

Sensory. If the problem appears to be due to hypersensitivity to sensory stimuli, sensory-based interventions may be helpful, such as auditory integration training, sensory integration, visual training, and Irlen lenses. Another strategy would be to remove these sensory intrusions from the person's environment.

Biomedical. Naltrexone is usually not prescribed to improve social interaction; however, research studies and parent reports have often indicated improved social skills when given Vitamin B6 and magnesium, and/or dimethylglycine (DMG)(see the Autism Research Institute's Web site).

Social. A treatment strategy to improve social behavior is using 'social stories,' developed by Carol Gray. This involves presenting short stories to teach socially appropriate behaviors. These stories are used to teach the individual to understand the behavior of themselves and others better. For information about social stories, contact Carol Gray at: Consultant to Students with Autism, Jenison Public Schools, 8375 20th, Jenison, MI 49428, U.S.A.

Bibliography:

Bauman, M.L., & Kemper, T.L. (1994). Neuroanatomic observations of the brain in autism. In M.L. Bauman & T.L. Kemper (Eds.), The neurobiology of autism. Baltimore: Johns Hopkins UP.
Courchesne, E. (1987). A neurophysiological view of autism. In E. Schopler & G.B. Mesibov (Eds.), Neurological issues in autism. New York: Plenum Press.
Donchin, E., Ritter, W., & McCallum, W.C. (1978). Cognitive psychophysiology: The endogenous components of the ERP. In E. Callaway, P. Tueting, & S. Koslow (Eds.), Event-related brain potentials in man. New York: Academic Press.
Edelson, S.M., Arin, D., Bauman, M., Lukas, S.E., Rudy, J.H., Sholar, M., & Rimland, B. (1999). Auditory integration training: A double-blind study of behavioral, electrophysiological, and audiometric effects in autistic subjects. Focus on Autism and Other Developmental Disabilities, 14, 73-81.
McEachin, J.J., Smith, T., & Lovaas, O.I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal of Mental Retardation, 97, 359-372.